We found that time from B. anthracis exposure to symptoms or hospitalization and presentation skin and limb findings did not differ comparing survivors and non-survivors. At presentation proportionately more non-survivors had histories of excessive alcohol use (p=0.05) and required vasopressors and/or mechanical ventilation (p&#8804;0.01 for each individually). Non-survivors had higher sequential organ failure assessment scores (SOFA, meanSEM) (7.30.9 vs. 1.20.4, p<0.0001). Antibiotic, surgery, and anthrax polyclonal immune globulin treatments did not differ comparing survivors and non-survivors. Eleven of the 14 patients requiring vasopressors during hospitalization died. Presentation SOFA or vasopressor requirement during hospitalization may identify injectional anthrax patients for whom beneficial but limited adjunctive therapies might be considered.